A Girl's Best Friend

From the time a woman hits puberty until shes finished with menopause, hormones have a lot of say; some days, theyre screaming. Hormones affect mood and health, and those two aspects of a woman affect everything from how she close she wants to snuggle with her spouse to how much work she can pound through at the office.

Women have unique nutritional needs compared to men because of key biological differences," said Sarah Sullivan, marketing manager, DSM. These differences include a slower metabolism than men, which means her diet allows for fewer empty calories, so those foods she eats better be nutritious. Osteoporosis and autoimmune diseases are more likely to occur in women than men. And then there are the obvious differences of menstruation, pregnancy, nursing, menopause and breast health.

And its not like she has a lot of time to sit around contemplating why she feels certain ways and which research studies show a nutrient helps with a specific female problem. Shes busy. She has to pick up Tommy at soccer practice in a half an hour, has to create a stellar sales presentation by Monday morning and has to prepare dinner for the in-laws on Friday.

Men are also busy, but theres something different about a woman and her focus on natural health. She can fit time in her stressful schedule to read the latest headline about vitamins, and she certainly looks at labels. She can definitely find the time to make sure she is as healthy as possible to meet all the demands in her life. And shes willing to turn to supplements to help achieve her health goals.

Weve seen studies showing women make up to 85 percent of health product purchases," said Dean Mosca, president, Proprietary Nutritionals Inc. Consequently, the women's health market continues to be abundant with excitement. Crafting a product or a product line that addresses their health and wellness concerns, based on solid science, at the right price points and with the right marketing messages, is a winning prospect."

Plus, as Paula Nurnberger, marketing manager, PL Thomas, noted, Women tend to immediately endeavor to address a health issue and also have a more preventive mindset than do men."

As the population ages, women are becoming more focused on prevention. "There is a greater interest in products that address issues experienced by older women, such as for post menopause," said R.V. Venkatesh, managing director, Gencor Nutrients. "As life expectancy grows, this is likely to increase.  There are also more products being developed specifically for women for better quality of life, such as libido and energy products."

With womens focus on health, its no wonder the amount of media designed to get their attention. Health is a popular topic on talk shows, news segments and magazines directed toward women. Unfortunately for this industry, the media seem to love to promote studies that show how harmful supplements can be, with rarely a mention of the millions of research papers showing their benefits.

Within the last year, two big studies were published and subsequently covered by mainstream media that showed supplements may harm women. Despite the politics behind the studies, many in the industry feared women would throw away their calcium and multivitamins for good.

Next: "Multivitamins Increase Mortality"

Multivitamins Increase Mortality

In October 2011, researchers from the University of Minnesota, Minneapolis, reported use of multivitamins, vitamin B6, folic acid, iron, magnesium, zinc and copper were all associated with increased risk of death in older women.¹ The association between supplement intake and mortality risk was strongest with iron. However, what was little reported was the authors of the study found use of most supplements was not associated with reduced total mortality, and calcium supplements appeared to reduce risk the of mortality.

For this study, researchers collected information from the Iowa Womens Health Study to examine the association between vitamin and mineral supplements and mortality among 38,772 older women (average age 61.6 years). Self-reported supplement use increased substantially between 1986 and 2004, with 62.7 percent of women reporting use of at least one supplement daily in 1986, 75.1 percent in 1997 and 85.1 percent in 2004.

Headlines such as, "Study Flags Risk of Daily Vitamin Use Among Older Women" from USA Today and "Is This the End of Popping Vitamins?" from The Wall Street Journal flew across magazine pages and were emailed back and forth among women and their friends.

But, not so fast. The study findings were questioned by many in the industry. Steve Mister, president and CEO, the Council for Responsible Nutrition (CRN), suggested this study may have fulfilled a political agenda more than a scientific one. He said the study is full of opinions, not science. He pointed to statements within the study, such as, Cumulative effects of widespread use, together with food fortification, have raised concern regarding exceeding upper recommended levels."

The iron use in the study also raised questions. Mister pointed out because the women reported such high dosages, its likely the participants were taking iron under a physicians care for an iron deficiency. He said iron deficiency, rather than the iron supplements, may itself have resulted in a shortened lifespan.

Accompanying the study, the journal included a commentary by Goran Bjelakovic, M.D., D.M.Sc., of the University of Nis, Serbia, and Christian Gluud, M.D., D.M.Sc., Copenhagen University Hospital, Denmark, who Mister said are well-known for their negative view of supplements. In the spirit of true scientific discourse, wouldnt it have been more appropriate to invite a commentary from a researcher who might have looked at the data in its entirety, with sufficient lead time, and provided a different perspective?" Mister questioned.

Duffy MacKay, N.D., vice president, scientific and regulatory affairs, CRN, added its important to keep in mind this wass an associativenot a cause-and-effectstudy. But beyond that, MacKay said the scientists may have manipulated the data so benefits were adjusted away. When the authors did their initial [minimum adjusted] analysis, it appears they actually found benefit for many of the supplements, not just calcium; yet, instead of stopping there, they went on to further adjust the data, possibly until they found statistics worthy of this publications acceptance."

And, as the authors reported more supplement use as the women were older, its difficult to tell how many of the subjects started taking supplements only after they became sick. So perhaps disease led to both supplementation and death, rather than supplements leading to disease and death.

Michael McBurney, Ph.D., head of scientific affairs, DSM, noted supplement users are more likely to be at one health extreme or the other. They are more likely to engage in healthy practices (less likely to smoke, drink alcohol in moderation, exercise regularly, and eat more fruits, vegetables and whole grains); yet, those who are sick also often turn to supplement use. "Because people at both extremes share many common attributes, it is an oversimplification to assume that statistics correctly associated all the risk to a single parameter," he said.

He also questioned the approach of analyzing each vitamin separately and the choice of control. "Many supplement users take multiple supplements, in which case, a clean supplement-mortality risk does not exist. And statisticians know the likelihood of finding a significant effect which is a random association, increases with the number of comparisons being made. So, the study has many flaws."

Next: "Study Reports Calcium Ups Heart Attack Risk"

Study Reports Calcium Ups Heart Attack Risk

In another provocative study earlier in the year, the British Medical Journal reported women who started taking calcium supplements, with or without vitamin D, modestly increased their risk of cardiovascular events, especially myocardial infarction.² Women not taking personal calcium supplements at the start of the trial, but who started taking a combination of calcium and vitamin D supplements for the study, were at an increased risk of cardiovascular events after the trial. Conversely, the authors reported women who were taking personal calcium supplements at the start of the trial, and then started combining calcium and vitamin D supplements did not alter cardiovascular risk.

Again, industry was quick to question the study's conclusion. John Hathcock, Ph.D., senior vice president of scientific and international affairs, CRN, noted the results were a statistical methodology effect, rather than a true health effect. And Cara Welch, Ph.D., vice president, scientific and regulatory affairs, Natural Products Association (NPA), also had serious concerns, calling the analysis flawed.

In this meta-analysis, researchers incorporated data from the Womens Health Initiative Calcium/Vitamin D Supplementation (WHI CaD) study with eight other studies. The WHI CaD Study was a seven-year, randomized, placebo-controlled trial of calcium and vitamin D (1 g/d calcium and 400 IU/d vitamin D) in 36,282 community-dwelling postmenopausal women. Of the 16,718 women (46 percent) who were not taking personal calcium supplements at randomization, calcium and vitamin D supplementation increased cardiovascular events from 13 percent to 22 percent, whereas women taking personal calcium supplements before the study did not increase or decrease their cardiovascular risk by taking either calcium or vitamin D.

In earlier WHI CaD Study analyses, researchers found no association between calcium and vitamin D supplementation and heart disease or stroke, but the researchers in the current study said this may be due to including women who already were taking supplements in the dataset.

Hathcock noted, Instead of considering these findings a coincidence or a statistical abnormality as there are with many analyses of large pools of data with many variables, the authors instead suggest that the abrupt change in blood calcium levels after supplementation is what causes the effect. It seems more likely that findings are a procedural or statistical anomaly."

Welch added, The eight studies that were included last time werent originally set up to look at cardiovascular events, and the WHI CaD Study reported no adverse effect of calcium and vitamin D on any cardiovascular end point. This latest analysis does not present compelling evidence against calcium and vitamin D, and in fact, there are many more studies touting the beneficial effects for both." She cautioned that all individuals who use calcium supplements for bone health, and especially those under the direction of a physician, should continue their supplementation and not be swayed by this analysis. We have seen over and over the argument that Americans can get all the nutrients they need from a balanced diet. But the fact is, most dont."

Nurnberger added this study highlights the need for vitamin/mineral combinations. "At PL Thomas, we are vehemently educating both industry and consumers that a specific vitamin K (vitamin K2, menaquinone-7) is an absolute necessity in calcium/vitamin D formulations for this very reason. Calcium can go rogue; it has a mind of its own by acting upon its affinity for being deposited in cardiovascular arteries, which is very dangerous."

Kevin J. Ruff, Ph.D., MBA, director of scientific and regulatory affairs, ESM Technologies, also noted calcium that is ingested, but isnt properly stored in the bones or excreted in the urine, can be inappropriately deposited in artery walls, elevating the risk for cardiovascular events. "The key to preventing this unwanted side effect of calcium supplementation is to ensure adequate vitamins and minerals, particularly vitamin D3, vitamin K2 and magnesium, are being co-administered to more fully address the totality of the calcium dysregulation," he said. "This vitamin and mineral combination will help ensure the calcium is utilized to build bone density while minimizing any added cardiovascular risk."

Thomas Chang, president, Sunbio Corp., said taking calcium is ultimately a personal decision. "Will I take calcium and risk the cardiovascular disease (CVD) or not take calcium and risk the osteoporosis? Thus, more studies are required. Personally, I think the risk of not taking calcium is far greater."

Bob Green, president, Nutratech Inc., said the media like to hype the results of every new study that comes along offering provocative findings. "However, a single study is never the be-all and end-all," he said. "As an industry, we must help consumers see the preponderance of evidence."

Next "Marketing Matters"

Marketing Matters

Studies such as these highlight the need for manufacturers to establish a good relationship with women before the bad news hits, and keep them updated on studies that show the benefits of natural products, which media aren't so quick to report.

Take full advantage of social media and permission-based marketing (e-blasts)," Mosca recommended. "Keep all messages highly educational and in a warm, friendly tone. Women enjoy communicating to others about their experiences, sharing information about products and brands they like and dislike. Get into these conversations, and you will be building a community of brand loyal consumers."

Nurnberger said many women are turned off by hype and overselling of promises, so she suggested using open, honest communication that translates features and benefits.

April Knell, marketing coordinator, ESM Technologies, said the product message must relate to or connect with consumers. "It may be that a product helps them with keeping their family healthy, with maintaining inner and outer beauty, or with just feeling better," she said. "The product message must deliver emotional power to that woman."

This social aspect plus truthful advertising can come from a celebrity women already trust. Maryanne Christiano-Mistretta, marketing, Ecuadorian Rainforest, said women know prevention is key, but like to be reminded by other women. "Having a spokesperson for a product can help greatly. For example, the Oprah effect: when Oprah mentioned açai on her show, sales for the superfruit spiked tremendously."

Benjamin Voiry, business manager, NAT life, said product manufacturers can best market women's health products by targeting precise womens problems. "For example, a product for menopause is too vague," he said "We found from studies that the main issues during menopause are  hot flashes, insomnia, mood disorders, irritability and loss of libido. Reduction of hot flashes is the most expected sensible benefit that women expect from a product."

Once women are convinced products will work for them, they need a delivery format that works in their lives. Mosca said bars remain popular for women because they tend to enjoy snacking on healthier foods that provides a health or nutrition benefit. " Infused waters are also increasingly popular among women; and although it seems this market may be saturated, there is indeed room for more, as long as the price points are in line," he said.

Chase Hagerman, business development and marketing manager, Chemi Nutra, suggested manufacturers have varied delivery forms. "It would likely be wise to have two or more delivery forms for each product," he said. "A large consumer base either has trouble swallowing pills or dislikes choking down handfuls of pills each day. With this in mind, alternative delivery forms are becoming more common. Liquids and drinks are rapidly gaining in popularity; however, the human stomach and diet can only allow so many ounces of liquid."

Physical beauty and health will always be important to women, and consumers are more willing to accept health and beauty as one in the same. "The limit between the cosmetic and health segments is now blurred," said Sébastien Bornet, director of global marketing, Horphag Research. "There is a growing interest in beauty-from-within solutions, which often come on top of using topical applications."

Because every woman's experiences and needs are individual and distinct, supplements, functional foods and beverages will continue to become more diverse, according to Nurnberger. "Women, predominantly more so than men, are used to using topicals; it's second nature. Women also tend to be more willing to experiment with new products and to take their time checking them out in the aisles. In addition, women tend to do their research about health products both in general and particular brands." She added, "Men more so than women tend to 'compress' their supplements into pill consumption. Women tend to spread out their consumption with beverages, chewables, shakes, pills, functional foods and topicals."

Women's needs change from the womb to post menopause, and natural supplements can help them make that trip a joyous one. But it's important for product manufacturers to step in when the media goes wild with damaging reports based on inaccurate science. Do that, and supply the scientific ingredients in a format she likes, and your product just may end up in her purse as she heads to the soccer field for Tommy's big game and as she boards the plane for her next business trip.

Next: Chart "Addressing Women's Needs"

Addressing Women's Needs

References Listed on the Next page.

References:

1. Mursu J, et al. Dietary supplements and mortality rate in older women: the Iowa Women's Health Study." Arch Intern Med. 2011 Oct 10;171(18):1625-33.

2. Bolland MJ et al.  " Calcium supplements with or without vitamin D and risk of cardiovascular events: reanalysis of the Women's Health Initiative limited access dataset and meta-analysis." BMJ. 2011 Apr 19;342:d2040. doi: 10.1136/bmj.d2040.

3. Cogswell ME et al. Iron supplementation during pregnancy, anemia, and birth weight: a randomized controlled trial. Am J Clin Nutr. 2003 Oct;78(4):773-81.

4. Knapen MH, Schurgers LJ, Vermeer C. Vitamin K2 supplementation improves hip bone geometry and bone strength indices in postmenopausal women." Osteoporos Int. 2007 Jul;18(7):963-72

5. Dawson-Hughes B et al. "A controlled trial of the effect of calcium supplementation on bone density in postmenopausal women." N Engl J Med. 1990 Sep 27;323(13):878-83.

6. Schaafsma A, Pakan I. "Short-term effects of a chicken egg shell powder enriched dairy-based products on bone mineral density in persons with osteoporosis or osteopenia." Bratisl Lek Listy. 1999 Dec;100(12):651-6.

7. Chang A et al. "The Effect of Herbal Extract (EstroG-100) on Pre-, Peri- and Post-Menopausal Women: A Randomized Double-blind, Placebo-controlled Study." Phytother Res. 2011 Sep 2. doi: 10.1002/ptr.3597.

8. Suzuki N et al. " French maritime pine bark extract significantly lowers the requirement for analgesic medication in dysmenorrhea: a multicenter, randomized, double-blind, placebo-controlled study." J Reprod Med. 2008 May;53(5):338-46.

9. Evans M et al.  "The effect of synthetic genistein on menopause symptom management in healthy postmenopausal women: a multi-center, randomized, placebo-controlled study." Maturitas. 2011 Feb;68(2):189-96.

10. Heyerick A et al. "A first prospective, randomized, double-blind, placebo-controlled study on the use of a standardized hop extract to alleviate menopausal discomforts." Maturitas. 2006 May 20;54(2):164-75.

11. Laidlaw M, Cockerline CA, Sepkovic DW. "Effects of A Breast-Health Herbal Formula Supplement on Estrogen Metabolism in Pre- and Post-Menopausal Women not Taking Hormonal Contraceptives or Supplements: A Randomized Controlled Trial." Breast Cancer (Auckl). 2010 Dec 16;4:85-95.

12. McMurdo ME et al. "Cranberry or trimethoprim for the prevention of recurrent urinary tract infections? A randomized controlled trial in older women." J Antimicrob Chemother. 2009 Feb;63(2):389-95.

13. Høivik HO et al. "[Prevention of recurrent cystitis in fertile women. A double-blind comparison of Hiprex and placebo in general practice].  [Article in Norwegian]" Tidsskr Nor Laegeforen. 1984 Jun 10;104(16):1150-2.

14. Judge MP, Harel O, Lammi-Keefe CJ. " Maternal consumption of a docosahexaenoic acid-containing functional food during pregnancy: benefit for infant performance on problem-solving but not on recognition memory tasks at age 9 mo." Am J Clin Nutr. 2007 Jun;85(6):1572-7.

15. Dunstan JA et al. " Cognitive assessment of children at age 2(1/2) years after maternal fish oil supplementation in pregnancy: a randomised controlled trial." Arch Dis Child Fetal Neonatal Ed. 2008 Jan;93(1):F45-50. Epub 2006 Dec 21.

16. Jacobson JL et al." Beneficial effects of a polyunsaturated fatty acid on infant development: evidence from the inuit of arctic Quebec."  J Pediatr. 2008 Mar;152(3):356-64. Epub 2007 Oct 22.

17. Bakker EC et al. " Relationship between long-chain polyunsaturated fatty acids at birth and motor function at 7 years of age." Eur J Clin Nutr. 2009 Apr;63(4):499-504. Epub 2007 Dec 19.